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SAN A., IQUIN COUNTYPUBLIC HEALTH S�,^ES <br /> j EI4VIRONMENTAL HEALTH DIVISION <br /> l 304 EAST WEBER AvENUF-,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT (fitG✓�•✓ —� HUSINESSJAGENCY <br /> ADDNZEss 837 5AAW Road,. ,S�v&m n, <br /> PLwlm Zq �6 ?-1041t FACSIMILE ,97109 ?- ` <br /> TENTATIVE`APPOINTMENT DATE 11I11E <br /> (Please Ohre 7 to 10 business days from date of application submittal) 2 5 2001 <br /> CHECK BOX 70 EXPEpTrE RLigUES7-P40 fi— pIJEST PROCESSED IN 3 BUSINLSS DAYS <br /> p t rl�-R"ICCs <br /> SIGNATURE OF APPLICANT _ DATE 2 { <br /> /FIYE ADD <br /> L <br /> 5. <br /> 3s'z8 <br /> ' 3 5 AS' r►�-�-_ <br /> .SSS�� ►�. <br /> a 957 el C. <br /> S <br /> ENVIRONMENTAL HEALTH DIVISION FIDS <br /> UNDE WWUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FPZRMY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FWD FACILITY O SOLID WASTE vl`MCLA <br /> UNDERfMiOUM TAM((M0F&OR NG1REM0VAQ ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH CI PKK TREATMENT PLANT <br /> ❑ T19WO PFRM TTED FACILITY ❑ MOTELAWTEL ❑ PUMPER TRUCKIYARD=EM TOILM <br /> ❑ T'ATrOWBODY PIERCING C1 POOLISPA 0 LAND U3E APPLICATNt7tt SliMz <br /> 0 MIEDICAL WASTE FACILITY Q PUBLIC WATER SYSTEJM Q OTHER OPLEASE SPECIFY ABUV) <br /> 1. List up to ten addresses in the Space above. Seloot the type(s)of fifes from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mal! o Abu <br /> q, 0Ms indicate Wom. <br /> 2- EHD will notify the applicant it any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days alter receipt of application. The files <br /> w0i be held for a maximum of five business days for review. Appoint rents should be scheduled <br /> accordingly, <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganked by EHD staff at the expense <br /> of the applicant Future'fiie reviews by the same applicant may require a;78.00 deposit prior to review. <br /> 5. * MTATIVE appointment dates must be confinned with EHD staff. <br /> 6. Applications received after 3.04 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE '!"IME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />